Performance Evaluation Checklist

COLOSTOMY and ILEOSTOMY CARE

Descriptive Interpretation for Actual Score:

2 – Very Good
1 - Good
0 – Note Performed

Name of Student:
_____________________________________________________________________
Year/ Clinical Group: _________________ School Year:
____________________________________
Term: ___________ First Semester ____________ Second Semester
_____________ Summer
Inclusive Dates of Clinical Rotation:
_______________________________________________________
Instructor:
________________________________________________________________________
___

Purposes:

 Clean stoma and peristoma

 Prevent stoma and peristoma excoriation and leakage

 To prevent infection

 To provide clean ostomy pouch for fecal evacuation

SCORE
COLOSTOMY and ILEOSTOMY CARE
2 1 0

Procedure Scientific Rationale 2 1 0

1. Check the client’s condition before
applying the procedure
2. Gather equipment needed: flange
• ostomy bag and clip,
• scissors
• stoma measuring guide
• waterproof pad
• pencil
• Adhesive remover for skin,
• Skin prep stomahesive paste or
powder
• wet cloth,
• non-sterile gloves
• additional cloths
3. Identify the patient and review the
procedure. Encourage the patient to
participate as much as possible or
observe/assist patient as they complete the
procedure
4. Perform hand hygiene and observe
appropriate infection control measures
5. Provide privacy
Place waterproof pad under pouch
6. Apply gloves. Remove ostomy bag, and
measure and empty contents. Place old
pouching system in garbage bag
7. Remove flange by gently pulling it
toward the stoma. Support the skin with
your other hand. An adhesive remover may
be used
8. Clean stoma gently by wiping with warm Aggressive cleaning can cause
water. Do not use soap.
9. Assess stoma and peristomal skin
Assessment of the condition of the
patient is important to determine any
underlying problems
Equipments needed for the procedure
should be place beside the bedside of
the patient to properly perform the
procedure without interruption
Proper identification complies with
agency policy.
Encouraging patients to participate
helps them adjust to having an ostomy
This prevents the spread of
microorganisms
The pad prevents the spilling of
effluent on patient and bedsheets
Prevent contamination and infection
Gentle removal helps prevent skin
tears. An adhesive remover may be
used to decrease skin and hair
stripping.
bleeding. If removing stoma adhesive
paste from skin, use a dry cloth first.
A stoma should be pink to red in
colour, raised above skin level, and
moist
(Skin surrounding the stoma should be
intact and free from wounds, rashes,
or skin breakdown. Notify wound care
nurse if you are concerned about
peristomal skin)
10. Measure the stoma diameter using the The opening should be 2 mm larger
measuring guide (tracing template) and than the stoma size.
cut out stoma hole Keep the measurement guide with
patient supplies for future use.
11. Prepare skin and apply accessory Accessory products may include
products as required or according to agency stomahesive paste, stomahesive
policy powder, or products used to create a
skin sealant to adhere pouching
system to skin to prevent leaking.
Wet skin will prevent the flange from
adhering to the skin
12. Remove inner backing on flange and The warmth of the hand can help the
apply flange over stoma. Leave the border appliance adhere to the skin and
tape on. Apply pressure. Hold in place for 1 prevent leakage
minute to warm the flange to meld to
patient’s body. Then remove outer border
backing and press gently to create seal.
13. Apply the ostomy bag. Attach the clip This step prevents the effluent from
to the bottom of the bag. soiling the patient or bed
14. Hold palm of hand over ostomy pouch The flange is heat activated
for 2 minutes to assist with appliance
adhering to skin.
15. Clean up supplies, and place patient in a Removing garbage helps decrease
comfortable position. Remove garbage odour.
from patient’s room.
16. Perform hand hygiene This minimizes the transmission of
microorganisms
17. Document procedure Follow agency policy for
documentation. Document appearance
of stoma and peristomal skin, products
used, and patient’s ability to tolerate
procedure and assistance with
procedure
18. Refer immediately if there are abnormal The attending physician further assess
or untoward signs and symptoms seen or the patient for any complications or
assessed during the procedure to the abnormalities
physician of the patient

TOTAL POINTS:
TOTAL SCORE:
TRANSMUTED GRADE: